Advanced Gynecologic Services

Hysterosalpingography (HSG)

A frequent cause of infertility is tubal obstruction. To determine if blockage is present, and to examine and evaluate the overall uterine cavity, a hysterosalpingography, or “dye” x-ray test, is conducted. A simple and well-tolerated procedure, HSG’s are performed on an outpatient basis.

Polycystic Ovary Syndrome (PCOS)

The most common cause of ovulation disorder, Polycystic Ovary Syndrome (PCOS, occasionally referred to as Stein Leventhal Syndrome) can be the cause of irregular menstrual cycles, elevated levels of testosterone, and small cysts in the ovary. Also considered a pre-diabetic condition, it’s no surprise that obesity significantly worsens PCOS. Interestingly, many of the symptoms associated with PCOS can be successfully managed with weight loss. Other treatment options such as medications for ovulation and metformin can be effective, while surgery is occasionally recommended. Fortunately, most patients benefit from medical treatment of PCOS.

Fibroids

By far the most common gynecologic tumor, most fibroids are asymptomatic. That is, they don’t cause symptoms or issues. Some fibroids however can lead to pain, bleeding, and infertility. In these cases, minor surgery – including laparoscopy or da Vinci (robotic) - is normally the best option. In some cases medications may be used to simply shrink the fibroids, though this is only a temporizing treatment. Typically, if fibroids are causing clinically important issues, surgery is the best option.

Endometriosis

Sometimes the endometrium (the inner tissue that lines the uterus and is shed each month during menstruation) can grow outside of the uterus, often on fallopian tubes or ovaries. This is called endometriosis, and can cause pain during menstruation or intercourse, ovarian cysts, and infertility. While some clients do not experience these symptoms, the definitive diagnosis is achieved from surgery in the form of laparoscopy, da Vinci (robotic), or traditional open surgery. Medicinal treatments such as Lupron, Depo-Provera, letrozole and Danazol can also be effective, and are occasionally prescribed following a surgical procedure. An intrauterine device, or IUD, is also a treatment option for some clients.

Recurrent Pregnancy Loss (recurrent miscarriages)

Women who miscarry two or more times during their first trimester are experiencing Recurrent Pregnancy Loss (RPL). While the most common cause of recurrent pregnancy losses is a genetically abnormal embryo, other causes for RPL can include immunologic diseases and chronic medical diseases such as thyroid disease, as well as maternal genetic disorders. Structural abnormalities of the uterus can also cause RPL, which may include uterine duplication, or a septate or unicornuate uterus. Depending on the specific causes, many clients with RPL can be effectively treated, providing the opportunity to carry a successful pregnancy with chances as good as women without RPL.

Uterine and Vaginal Abnormalities

Most commonly associated with Recurrent Pregnancy Loss though occasionally related to infertility, uterine abnormalities can also be the result of uterine duplication. Of these, the vast majority are septate abnormalities, which are easily correctable with a relatively minor surgical procedure.

Vaginal abnormalities are less common. Occasionally associated with infertility, an obstructed vagina and vaginal septum are two examples of vaginal abnormalities, which depending on the type can be corrected using the proper surgical means.

Premature Ovarian Failure

Though not a common cause of infertility, premature ovarian failure (also called primary ovarian insufficiency) occurs when the amount of eggs the ovaries produce diminishes considerably or ceases altogether. While the exact cause may not be known, a genetic issue may be a contributing factor. Treatment options are limited, and normally donor eggs are the recommended solution.

Pelvic Pain

The causes of pelvic pain are as broad as the term is generic. Endometriosis, scar tissue, ovarian cysts, uterine fibroids, and obstructed fallopian tubes are just a few of many examples. Thus the importance of a professional diagnosis. A thorough History & Physical, ultrasound, CT or MRI, and laparoscopy are all diagnostic candidates for someone experiencing pelvic pain. Following diagnosis, treatment is entirely contingent upon the contributing cause(s).